Specialist II

At ForHealth Consulting we partner with purposeful organizations to make the healthcare experience better: more equitable, effective, and accessible. We aim to transform the health care experience to one that addresses the needs and concerns of the individual and is inclusive of all.

The Third Party Liability & Benefit Coordination (TPL&BC) business teams at ForHealth Consulting focus on identifying and coordinating benefits and performing cost avoidance, recovery, lien verification, and asset verification activities for state Medicaid programs, including MassHealth. As a member of the TPL Estate Recovery Unit, you would assist in recovering funds from estates of certain MassHealth members after their death. Estate recovery collections are deposited into the state’s general fund, which pays for programs and services benefitting everyone in Massachusetts.

If you are interested in using and applying your estate planning, probate, and real estate closing knowledge in a remote work environment with state benefits, this is an excellent opportunity for you.

GENERAL SUMMARY OF POSITION:

Under the general direction of the Specialty Programs Unit Manager, the Specialist II serves as a resource to the Center for Healthcare Financing (CHCF) staff primarily in matters concerning estate recovery. This individual will ensure the integrity of collection outcomes, according to federal and state estate recovery regulations.

Responsibilities

MAJOR RESPONSIBILITIES:

• Continue to refine and enhance current operations, implementing innovative methods to identify new cases, verify claims and recover payments originally paid by Medicaid and/or other state funded programs based on federal and state statutes and regulations.
• Research, maintain and understand compilation of all Federal and State statutes and regulations pertaining to Third Party and Estate Recovery to ensure Medicaid is the payer of last resort.
• Maintain a caseload as assigned, following established protocols
• Identify benefits paid by Medicaid and calculate the total value to be recovered in each case.
• Represent the best interest of the Medicaid program consistent with the goals and objectives of CHCF
• Request and produce claims history printouts including all service reports from Medicaid history databases for recipient payment history.
• Investigate and document all case related matters and relevant financial and medical history in order to support a claim against the probate estate or third party settlements of a Medicaid member.
• Provide training of support staff
• Maintain and update Recovery training manual
• Maintain all case records as required for an established time period
• Communicate and collaborate with probate courts, attorneys, hospitals, insurance companies and other relevant entities to insure all Medicaid related Estate Recovery cases are referred to the unit and processed accordingly
• Conduct legal research through the use of public databases and web based applications and prepare legal memoranda and other case related documents for referral to Medicaid EHS legal department.
• Research record of ownership and title of real estate at the Registry of Deeds
• Perform other job related duties as required or assigned

Qualifications

REQUIRED QUALIFICATIONS:

• Bachelor’s Degree in Business Administration or equivalent experience
• 3 years related experience
• Paralegal certificate or equivalent experience working under a licensed attorney or in an equivalent legal setting
• Strong oral and written communication skills
• Knowledgeable of Massachusetts Statutes as it relates to Estate Recovery
• Understanding of Medicaid regulations as they govern eligibility requirements
• Proficient in Microsoft Office, web based solutions and scanning software
• Effective negotiation skills

PREFERRED QUALIFICATIONS:

• Third Party Recovery or collections experience
• Paralegal degree
• Proficient in Probate and Real Estate Law, Wills and Trusts, Chain of title research and insurance regulations pertaining to Medicaid qualifying annuities.
• Possess a thorough understanding and knowledge of the state and federal laws and the procedures relating to the recovery of medical assistance for members receiving Medicaid benefits.
• Previous experience communicating professionally and effectively with Board of Hearings (BOH) personnel, enrollment centers staff and managers, family and/or legal representatives of Medicaid members and the general public.
• Ability to track and organize the recording of Medicaid liens in Registry of Deeds
• Understand HUD settlement statements, state and federal taxes, appraisals, priority of liens and creditors, comparative market analysis, and probate-related appointments

Additional Information

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